Provider First Line Business Practice Location Address:
171 SPAULDING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13205-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-435-4612
Provider Business Practice Location Address Fax Number:
315-435-6280
Provider Enumeration Date:
11/29/2011